2020 special issue: Twenty years of breast reconstruction: Past, present, and future.

Breast reconstruction has evolved in the last 25 years to provide women with better autologous and implant-based options. The general trends of breast reconstruction have shifted to skin and nipple-areolar complex preservation, resulting in improved aesthetics and patient satisfaction. Autologous reconstruction has made a dramatic movement toward microsurgical reconstruction by free tissue transfer and has addressed lymphedema and breast sensation. Using the patient's own tissues, several aesthetic refinements have led to optimizing the cosmetic appearance of the reconstructed breast. Implant-based reconstruction has improved with the invention of form-stable silicone implants, acellular dermal matrix, and fat grafting. These positive trends will continue into the future. We hope that all women with a diagnosis of breast cancer will have the option of a consultation with a reconstructive plastic surgeon, ideally prior to undergoing resective surgery, to ensure they are aware of all reconstructive options to maximize their reconstructive result.

Breast Reconstruction: A Century of Controversies and Progress.

Breast cancer treatment has dramatically changed over the past century. Since Halsted's first description of radical mastectomy in 1882, breast reconstruction has evolved slowly from being considered as a useless or even dangerous procedure by surgeons to the possibility nowadays of reconstructing almost any kind of defect. In this review on the development of breast reconstruction, we outline the historical milestone innovations that led to the current management of the mastectomy defect in an attempt to understand the economic, social and psychological factors, which contributed to slow down its acceptance for several decades.

[History of breast cancer reconstruction treatment]. / Historique du traitement du cancer du sein.

The authors summarize in those six pages of drawings the history of breast cancer reconstruction treatment. The focus is on the variety of techniques available for breast reconstruction and on the debates around different indications.

Surgical anatomy of reduction mammaplasty: a historical perspective and current concepts.

Reduction mammaplasty is the volumetric reduction in the bulk of the breast. Techniques have evolved from primarily reducing the breast bulk to reducing with emphasis on functional and aesthetic outcome. The deeper understanding of the surgical anatomy of the breast has guided this development. While Paulus Aegina (sixth century AD), Dieffenbach (1848) and Gaillard-Thomas (1882) set the pace in glandular reduction; Pousson (1897) and Dehner (1908) focused on breast ptosis. It took quite some time before the enigma of the vascularization to the nipple areolar complex could be solved. Progress over a decade saw Thorek's (1922) free nipple grafting replaced by the periareolar de-epithelialization introduced by Schwarzmann (1930); which subsequently gave way to the Gillies and McIndoe (1939) skin-gland undermining technique. The era of breast remodeling while preserving the nipple areolar complex was soon ushered forward. This was driven by Arie (1957), Strombeck (1960) and Pitanguy (1961). The preservation of the subdermal plexus became crucial whilst retaining sensory supply to the breast as the pectoral fascia was spared. Skoog's (1963) nipple transposition without skin-gland undermining formed the basis for modern day reduction mammaplasty. Aesthetics was in mind throughout this period as different skin incisions were developed and advanced following Dieffenbach's small submammary incision in 1848. Surgical landmarks that ensured reproducible aesthetic outcomes were described by Penn (1955) and Wise (1956). Liposuction-assisted reduction was introduced by Teimourian in 1985 and is best utilised in patients with predominantly fatty breast tissue.

[Pierre Mornard (1883-1929), unrecognized plastic surgeon]. / Pierre Mornard, (1883­1929), un plasticien méconnu.

Many operations of aesthetic surgery were described between 1920 and 1930. Several French surgeons are recognized as pioneers of the speciality. Pierre Mornard (1883-1929) published numerous articles of plastic and aesthetic surgery between 1925 and 1929 the date of his death. The articles were illustrated with drawings of surgery he had practiced. He described in 1929 the first abdominoplasty with umbilical transposition. Pierre Mornard can be considered a pioneer of aesthetic surgery.

Barbed sutures in breast reconstruction.

Postoperative closure techniques in breast reconstruction have remained largely unchanged over the past 75 years, despite recent use of adhesives and subcuticular staples and the advent of self-anchoring barbed sutures. In this article, the author discusses the applications for barbed sutures in breast reconstruction and describes specific techniques. Innovations in barbed suture material are also described, and the author's personal experiences are presented in comparison with traditional suturing techniques.

The evolution of breast reconstruction: a historical perspective.

Plastic surgeons have been performing operations to improve the aesthetic aspect of the breast for centuries. Throughout ancient times, great controversy produced many theories of how breast cancer occurred and the best treatment. Because of beliefs that closure of mastectomy sites could conceal tumor recurrence, breast reconstruction did not gain wide acceptance until the mid-1900s. Today, plastic surgeons have a variety of techniques to reconstruct the breast. The first autologous muscle flap for breast reconstruction was the latissimus dorsi myocutaneous flap, described in 1896 by Iginio Tansini. The introduction of Carl Hartrampf's transverse rectus abdominis myocutaneous flap and Robert J. Allen's deep inferior epigastric perforator flap have also provided excellent reconstructive options. With regard to augmentation, Vincenz Czerny attempted to enhance a woman's breast in 1895 with implantation of a lumbar lipoma. Soon after, surgeons used paraffin injections and polyvinylic alcohol sponge implantation, which yielded disastrous results. In 1961, Thomas Cronin and Frank Gerow promoted the first silicone implant, paving the way for today's silicone and saline prototypes. Although reduction mammaplasty techniques had originated centuries earlier than mastopexy methods, the advancements of both have largely paralleled one another. In 1949, the Wise pattern was introduced to preoperatively plan safer and predictable outcomes in breast reductions. Efforts to minimize scars were achieved with Claude Lassus' introduction and Madeleine Lejour's subsequent modification of the vertical scar mammaplasty. In hopes of fostering an understanding of current post-mastectomy procedures and instilling passion for innovating future techniques, we provide a near-complete, surgically focused historical account of the primary contributors to breast reconstruction.

Breast cancer surgery: an historical narrative. Part III. From the sunset of the 19th to the dawn of the 21st century.

The 20th century is marked by significant advances regarding the management of breast cancer. A clear trend towards less aggressive surgical operation was constantly noted. Modified radical mastectomy gradually replaced radical mastectomy during the second half of the 20th century, while during the last two decades breast-conservation therapy became the treatment of choice for the treatment of breast cancer. This type of therapy includes segmental mastectomy (either quadrantectomy or lumpectomy) with axillary lymph node dissection, followed by postoperative irradiation. Other significant advances during the 20th century include the introduction of systemic therapy (chemotherapy, hormonal therapy) and radiation therapy. Better patient follow-up, statistical analysis, development of staging systems and the introduction of frozen section, the development and wide use of mammography (including screening mammography), breast reconstruction following mastectomy and the development of newer diagnostic methods [including breast magnetic resonance imaging and the advanced breast biopsy instrumentation (ABBI)] are other advances that contributed to a better management of breast cancer patients. Sentinel lymph node biopsy has been introduced during the 1990 s in an attempt to reduce morbidity due to axillary lymph node dissection. Despite these advances, breast cancer remains a significant problem and represents a field of active and intense research.

The history and development of breast implants.

This review discusses the historical development of smooth and textured silicone gel filled implants, and examines the reasoning behind product development and aspects of surgical technique from a surgeon's perspective.

[Pioneers and martyrs: Delpech, Guinard, Pozzi]. / Pionniers et martyrs : Delpech, Guinard, Pozzi.

Jacques Mathieu Delpech, Aimé Guinard Samuel Pozzi, three famous surgeons of the 19th and early 20th century were murdered by patients. All three contributed to the history of plastic surgery. Delpech (1777-1832) carried out the first plastic surgery in France using a forehead flap to replace a loss of substance on the face, Guinard (1856-1911) did the first reduction mammaplasty. Pozzi (1846-1918) was probably the first to perform an operation of face lift on one of his patients but did not publish it. These three surgeons were killed by unbalanced patients they had operated of benign lesions.

Evolution in Tissue Expander Design for Breast Reconstruction: Technological Innovation to Optimize Patient Outcomes.

Tissue expander design in breast reconstruction has evolved substantially over the last 60 years. An insightful appreciation of breast aesthetics, coupled with competition among industry partners, has resulted in innovative and disruptive technology to benefit patients desiring immediate reconstruction following mastectomy. In this article, we discuss the evolution of breast expander technology and the implications in improving patient outcomes in breast reconstruction.

[40 years of silicone breast implants]. / Silikonbrystimplantater gjennom 40 år.

BACKGROUND: It is estimated that approximately 50,000 Norwegian women have silicone breast implants following breast augmentation or breast reconstruction. Their numbers are growing and doctors will more often be confronted with the health problems related to these implants. MATERIAL AND METHODS: This review is based on information retrieved from Medline and our clinical experience. RESULTS AND INTERPRETATION: The modern silicone breast implant is the product of four decades of development. The ongoing debate on health problems associated with the implants has been a vibrant stimulator for research, but a causal relationship between implants and the development of breast cancer and autoimmune defects has not been found. The implants are not, however, without complications; more research is required in order to improve the implants and for quality assurance of treatment and follow up.

[Historical evolution of breast reconstruction]. / Evolución histórica de la reconstrucción mamaria.

Breast reconstruction forms an essential part of the treatment of mastectomised women. Although the first attempts to reconstruct a breast date back to the end of the XIX century, it was not until the 1970s that there was a progressive development of the different techniques employed today. Until the 1970s, breast reconstruction was not popular, mainly because the teachings of Halsted, who believed that plastic surgery interfered with the local control of the cancer. When it was found that breast reconstruction did not have a negative influence on the neoplastic disease, but was instead of transcendental importance for the physical and psychological rehabilitation of the patient, its development benefited from several advances: the tendency towards less aggressive mastectomy techniques, which facilitate cutaneous covering; the introduction and progress of silicone breast prostheses; the submuscular implantation of the prostheses, which avoid local complications; the technique of breast tissue expansion; and great advances in the anatomical understanding of the different available flaps, especially musculocutaneous ones and those transferred microsurgically. Today the mastectomised patient can be offered reconstruction either using a silicone prosthesis or a completely autogenous reconstruction; the most recent advance is the introduction of microsurgical perforator flaps.

Breast implants under siege: an historical commentary.

Despite 3 decades of rapidly expanding application of polydimethylsiloxane as a relatively safe implantable biomaterial, the American public is being told by a vocal minority that its use in the breast implant may be dangerous. Most of the furor has been generated by consumer advocates with support of a handful of scientists who have expressed opinions, not well supported by facts, about the risks of these devices. These anxieties have been fueled in the public's mind by a media more interested in sensationalism than disciplined reporting. The controversy has complicated the regulatory process and has become politicized in the halls of State Legislatures and Congress. Remarkably, this controversy has not involved the many other biomedical applications of silicone. How has this controversy gathered momentum? What role has the government played and how have the professional, scientific, corporate, and patient communities responded to public concern? This discussion places the breast implant battle into an historical perspective.

Augmentation mammaplasty--a further review of 20 years using the polyurethane-covered prosthesis.

Augmentation mammaplasty continues to attract much attention. So far, it seems to be an operation with an indefinite endpoint regarding the longevity of results. It is also a procedure that has wide monetary implications and would often seem to be inappropriately used. With the advent of the latest polyurethane-covered prostheses, marketed under various trade names such as Meme, Replicon, and Optimam, a more predictable result can be obtained, at least for the first 6 years. Much controversy still exists, and in view of this, the authors have revised their long-term results and comments on important current aspects.

[Reduction of breasts ... Hans Schaller and the first mammaplasty in 1561. Contribution to history of medicine]. / Vom Amputieren der Brüste ... Hanns Schaller und die erste Mammaplastik 1561. Beitrag zur Medizingeschichte.

In comparison with other surgical procedures concerning the breast, the history of reduction mammaplasty is relatively short. Some authors have mistaken Paulos of Aegina for the pioneer in this field, although he occupied himself exclusively with gynaecomastia. Since some decades Hanns Schaller, the so-called "barber" of Augsburg, is considered to be the first surgeon to have performed a reduction mammaplasty by breast amputation in 1561. However, exact references have not been available so far. We found the original text containing the description of the procedure written by a contemporary in a rather unexpected place as well as some details about the surgeon. We conclude that Hanns Schaller was the first surgeon to undertake a reduction mammaplasty in an otherwise healthy woman in order to relieve her physical symptoms. Undoubtedly, his intentions were purely functional without any further aesthetic considerations.

21 year follow up of a DIEP (deep inferior epigastric perforator) flap: a tale of a "nulltiple".

Since the first description of "The free abdominoplasty flap for breast reconstruction" by Hans Holmstrom in 1979, [see Ref. 1] the use of lower abdominal tissue has revolutionised reconstruction of the breast. DIEP (deep inferior epigastric perforator) free flap offers an abundance of reconstructive material, aesthetically-pleasing results and limited donor site morbidity. We report our first case of breast reconstruction with what presently is known as DIEP flap, performed in 1991 at St. Andrew's Centre for Plastic Surgery and Burns in Essex, The United Kingdom and the recent follow up results. We also discuss the historical events surrounding the evolution of this unpublished case and other documented cases.